A Vessel for Change: Endothelial Dysfunction in Cerebral Small Vessel Disease

Quick, Sophie; Moss, Jonathan; Rajani, Rikesh M.; Williams, Anna

doi:10.1016/j.tins.2020.11.003

Cited by 79 publications

(68 citation statements)

References 136 publications

(146 reference statements)

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“…In addition, a positive relationship between WMLs severity and CMBs burden was demonstrated. The presence and burden of WMLs and CMBs indicate endothelial dysfunction (14), which contribute to platelet activation (29), and then decrease platelet response to aspirin. In addition, the severity of WMLs was positively correlated with cardiovascular comorbidities, which could contribute to aspirin resistance via cyclooxygenase (COX)-1-independent mechanisms (30).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

et al. 2021

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Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

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Section: Discussionmentioning

confidence: 99%

“…SVD is associated with an increased risk of recurrent ischemic stroke (4). In addition, SVD is associated with cerebral endothelium dysfunction (14) and impairment of brain network connectivity (15). Therefore, we hypothesized that SVD is associated with, and could affect the functional outcome of stroke with ATF.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

et al. 2021

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“…Other studies have also reported associations between systemic inflammation, incident brain infarcts, WMH severity, white matter microstructural abnormalities [30][31][32] and microcirculatory dysfunction [33]. Therefore, it is thought that systemic inflammation plays an aetiological role in cerebral small vessel disease [30], via endothelial dysfunction, subsequent impairment of blood flow and increased blood-brain permeability [34]. Our patients were studied in the stable state, but systemic inflammation may be episodic as COPD exacerbations are associated with increases in fibrinogen [35] and platelet aggregation [36].…”

Section: Plos Onementioning

confidence: 98%

Factors affecting brain structure in smoking-related diseases: Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease

et al. 2021

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Background Changes in brain structure and cognitive decline occur in Chronic Obstructive Pulmonary Disease (COPD). They also occur with smoking and coronary artery disease (CAD), but it is unclear whether a common mechanism is responsible. Methods Brain MRI markers of brain structure were tested for association with disease markers in other organs. Where possible, principal component analysis (PCA) was used to group markers within organ systems into composite markers. Univariate relationships between brain structure and the disease markers were explored using hierarchical regression and then entered into multivariable regression models. Results 100 participants were studied (53 COPD, 47 CAD). PCA identified two brain components: brain tissue volumes and white matter microstructure, and six components from other organ systems: respiratory function, plasma lipids, blood pressure, glucose dysregulation, retinal vessel calibre and retinal vessel tortuosity. Several markers could not be grouped into components and were analysed as single variables, these included brain white matter hyperintense lesion (WMH) volume. Multivariable regression models showed that less well organised white matter microstructure was associated with lower respiratory function (p = 0.028); WMH volume was associated with higher blood pressure (p = 0.036) and higher C-Reactive Protein (p = 0.011) and lower brain tissue volume was associated with lower cerebral blood flow (p<0.001) and higher blood pressure (p = 0.001). Smoking history was not an independent correlate of any brain marker. Conclusions Measures of brain structure were associated with a range of markers of disease, some of which appeared to be common to both COPD and CAD. No single common pathway was identified, but the findings suggest that brain changes associated with smoking-related diseases may be due to vascular, respiratory, and inflammatory changes.

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“…Cerebral small vessel disease (CSVD) is a series of clinical, imaging and pathological syndesmosis caused by various causes affecting the small arteries, arterioles, capillaries, venules and venules in the brain ( Quick et al, 2021 ). In China, lacunar infarction caused by CSVD accounts for 25–50% of ischemic stroke, higher than that in western countries ( Tsai et al, 2013 ).…”

Section: Pharmacological Mechanisms Of Tcm For Cerebral Small Vessel Diseasementioning

confidence: 99%

Traditional Chinese Medicine Intervenes in Vascular Dementia: Traditional Medicine Brings New Expectations

Bai

Zhang

2021

Front. Pharmacol.

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Vascular dementia (VD) is one of the most common forms of dementia, referring to a group of symptoms that mainly manifest as advanced neurocognitive dysfunction induced by cerebrovascular disease (CVD). A significant number of studies have shown that traditional Chinese medicine (TCM) has a clinical impact on VD and thus has promising prospects. There have been many discussions regarding the pharmacological mechanisms involved in treatment of the kidney, elimination of turbidity, and promotion of blood circulation. TCM has a prominent effect on improving patients’ cognitive function and quality of life. In this review, we summarize the pathogenesis of VD in modern medicine and TCM, traditional prescriptions, single-agent effective ingredients and their pharmacological mechanisms for treating VD, highlight TCM’s characteristics, and discuss TCM’s multi-targeted mechanism for the treatment of VD.

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A Vessel for Change: Endothelial Dysfunction in Cerebral Small Vessel Disease

Cited by 79 publications

References 136 publications

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Factors affecting brain structure in smoking-related diseases: Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease

Traditional Chinese Medicine Intervenes in Vascular Dementia: Traditional Medicine Brings New Expectations

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